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There are very few medical
conditions that affect 25% of a particular group (in this
case, women age 45 to 64) where fewer than 50% of those
affected seek treatment.
When it comes to the uncomfortable subject of incontinence, however, that is exactly the case. The following article (below), explains some of the issues associated with women's incontinence and outlines some non-invasive and drug-free methods for dealing with this serious problem and how biofeedback plays a role in helping some of those affected to find some relief. Live Well Incontinence: A 'hidden condition' for many women
Nine years ago, Lee Greenwood
developed a problem that, she says, could have made her hide
from the world.
Greenwood, a real estate agent, wet her pants while showing a home. It was the first of many accidents. "I had to do something about it," says Greenwood, 59, from Swarthmore, Pa. "I was not going to be a recluse." Though Greenwood's problem is common - 20% to 30% of women have it - her attitude is not. Fewer than half of women with incontinence seek treatment, says University of Pennsylvania nurse practitioner Diane Newman, who treated Greenwood. Some women are afraid to ask, she says, and others don't realize treatments are available.
"These patients are
devastated," Newman says. "It's still such a hidden
condition." Greenwood tried a variety of strategies for 1½
years - including pills to ease bladder spasms, a special
diet and even antidepressants. Nothing worked.
To give better guidance to doctors and patients, the National Institutes of Health in March published a new "state-of-the-science" statement, based on nearly 100 clinical trials and three comprehensive reviews, on non-surgical ways to treat incontinence. Surgery vs. non-surgery
While surgery is effective
for up to 90% of women, Newman says, it can be painful and
increases the risk of side effects, such as bleeding. Some
patients who have surgery develop new bladder problems, such
as the need to urinate frequently, Newman says.
The most promising
non-surgical approach - physical therapy called pelvic floor
muscle training - can cure half of women with stress
incontinence, in which urine leaks during activities such as
sneezing or coughing, the report shows.
Through the training, which
includes exercises called Kegels, patients strengthen
muscles around the urethra that control urination, says Jean
Wyman, report co-author and a nursing professor at the
University of Minnesota. Unlike medication, the exercises
have no harmful side effects and often can be taught by
women's primary care providers, she says.
But isolating tiny internal muscles isn't easy for everyone, Wyman says. Only about half of women can do the exercises correctly on their own. The rest need additional help from physical therapists or nurses, Wyman says. The report notes that the training works well when combined with biofeedback, which is especially helpful for women who have trouble isolating the correct muscles. Biofeedback sensors, attached to the pelvic floor, allow women to watch their muscles working on a computer monitor, helping them eventually learn to perform the exercises on their own, Wyman says. The report shows that it's also helpful to learn "bladder training," in which women follow a schedule when visiting the bathroom, with the aim of eventually going less frequently. Pelvic exercises also can prevent incontinence, says Robert Kane, a co-author of the March report and geriatrician and epidemiologist at the University of Minnesota School of Public Health. He recommends the exercises for women who are at higher risk, such as those who leaked during pregnancy, who had a forceps delivery, a hysterectomy or other pelvic surgery. Although about 20% to 30% of pregnant or postpartum women experience incontinence, Kane says, about half of them improve on their own without treatment.
Although some pregnant women
opt for Cesarean section for fear of damaging their pelvic
floor, Kane says there's no solid evidence that C-sections
prevent incontinence. The real risk, he says, appears to
come from the strain of being pregnant, rather than the
trauma of childbirth.
There's also no research to prove that incontinence is more common in those who have several children, compared with those who have only one. The risk of incontinence increases with menopause. After age 40, other risk factors - including diseases of aging such as diabetes - contribute more to incontinence than pregnancy, Wyman says. By the time women are elderly, those who have had children are no more likely to suffer incontinence than others. Use of electrical stimulation
Greenwood finally solved her
problem three months after Newman taught her to use
electrical stimulation at home. Greenwood still uses the
system, in which an internal sensor contracts the pelvic
floor muscles for her, half an hour a day. Although the
technique worked for her, the NIH report notes there's no
evidence that it benefits women in general.
Greenwood says she no longer lives in fear of accidents. She still uses a patch, which provides Detrol through the skin, and wears pads as insurance. She also does regular pelvic floor exercises. Wyman says women shouldn't be afraid to seek help - even if they've suffered for years. "At any age," Wyman says, "it's never too late." By Liz Szabo, USA TODAY
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